Widening spectrum of adverse effects caused by long-term use of proton pump inhibitors: A comprehensive review of literature
AS Mir, Zahoor A. Wani, Ajmal R. Baht, Khairi Mustafa Fahelelbom, Ankush Kumar, Sumeer Ahmed
Abstract
Proton pump inhibitors (PPIs) are frequently recommended for the management of gastroesophageal reflux disease (GERD) and peptic ulcers. This review article dwells upon various adverse effects that are associated with the extended use of PPIs and the mechanisms by which the PPIs lead to the progression of these complications, including Clostridium difficile infection (CDI) and pneumonia that develops due to impaired absorption caused by hypochlorhydria; cognitive impairment through decreased clearance of amyloid beta peptide and reduced synthesis of acetylcholine; osteoporosis that progresses due to reduced calcium absorption and disrupted bone remodeling through the effects on TRPM6/7 channels; Chronic kidney disease(CKD) caused by acute interstitial nephritis and vascular calcifications brought by hypomagnesemia; metabolic syndrome and Type-2 Diabetes Mellitus. As such, clinicians must exercise carefulness when prescribing PPIs for extended periods. The most important aspect is the careful assessment of the indication prior to commencing the treatment, as well as reassessing the indication throughout its long-term administration.